title: Pulmonary-vein isolation for atrial fibrillation in patients with heart failure.
abstract: BACKGROUND
  Pulmonary-vein isolation is increasingly being used to treat atrial fibrillation in patients with heart failure.
  
  
  METHODS
  In this prospective, multicenter clinical trial, we randomly assigned patients with symptomatic, drug-resistant atrial fibrillation, an ejection fraction of 40% or less, and New York Heart Association class II or III heart failure to undergo either pulmonary-vein isolation or atrioventricular-node ablation with biventricular pacing. All patients completed the Minnesota Living with Heart Failure questionnaire (scores range from 0 to 105, with a higher score indicating a worse quality of life) and underwent echocardiography and a 6-minute walk test (the composite primary end point). Over a 6-month period, patients were monitored for both symptomatic and asymptomatic episodes of atrial fibrillation.
  
  
  RESULTS
  In all, 41 patients underwent pulmonary-vein isolation, and 40 underwent atrioventricular-node ablation with biventricular pacing; none were lost to follow-up at 6 months. The composite primary end point favored the group that underwent pulmonary-vein isolation, with an improved questionnaire score at 6 months (60, vs. 82 in the group that underwent atrioventricular-node ablation with biventricular pacing; P<0.001), a longer 6-minute-walk distance (340 m vs. 297 m, P<0.001), and a higher ejection fraction (35% vs. 28%, P<0.001). In the group that underwent pulmonary-vein isolation, 88% of patients receiving antiarrhythmic drugs and 71% of those not receiving such drugs were free of atrial fibrillation at 6 months. In the group that underwent pulmonary-vein isolation, pulmonary-vein stenosis developed in two patients, pericardial effusion in one, and pulmonary edema in another; in the group that underwent atrioventricular-node ablation with biventricular pacing, lead dislodgment was found in one patient and pneumothorax in another.
  
  
  CONCLUSIONS
  Pulmonary-vein isolation was superior to atrioventricular-node ablation with biventricular pacing in patients with heart failure who had drug-refractory atrial fibrillation. (ClinicalTrials.gov number, NCT00599976.)
authors.affiliation: Cardiovascular Associates, Elk Grove Village, IL 60007, USA. mnktx@yahoo.com
authors.forename: Mohammed N
authors.initials: MN
authors.lastname: Khan
authors.forename: Pierre
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authors.lastname: Jaïs
authors.forename: Jennifer
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authors.lastname: Cummings
authors.forename: Luigi
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authors.lastname: Di Biase
authors.forename: Prashanthan
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authors.lastname: Sanders
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.forename: Steven
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authors.lastname: Hao
authors.forename: Sakis
authors.initials: S
authors.lastname: Themistoclakis
authors.forename: Raffaele
authors.initials: R
authors.lastname: Fanelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Potenza
authors.forename: Raimondo
authors.initials: R
authors.lastname: Massaro
authors.forename: Oussama
authors.initials: O
authors.lastname: Wazni
authors.forename: Robert
authors.initials: R
authors.lastname: Schweikert
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
authors.forename: Amin
authors.initials: A
authors.lastname: Al-Ahmad
authors.forename: Salwa
authors.initials: S
authors.lastname: Beheiry
authors.forename: Pietro
authors.initials: P
authors.lastname: Santarelli
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Antonio
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authors.lastname: Dello Russo
authors.forename: Gemma
authors.initials: G
authors.lastname: Pelargonio
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Volker
authors.initials: V
authors.lastname: Schibgilla
authors.forename: Aldo
authors.initials: A
authors.lastname: Bonso
authors.forename: Michela
authors.initials: M
authors.lastname: Casella
authors.forename: Antonio
authors.initials: A
authors.lastname: Raviele
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery*; D013318:Stroke Volume
chemical_list: D000889:Anti-Arrhythmia Agents